las

“To kill an error is as good a service as, and sometimes even better than, the establishing of a new truth or fact” ~ Charles Darwin (it's evolutionary baybeee!)

Thursday, December 5, 2013

A hypothetical.

I don't often appeal to emotion here. I'm not sure this hypothetical technically qualifies as such but here goes anyway.

The Hypothetical:

Imagine if you will your daughter or sister ... feel free to substitute any young woman ever, that you have been close to and cared for in what one might describe as a protective way. She's off to college soon. You worry that if she gets in trouble, and struggles a bit, that she'll have a good support system so far away from home, friends and family. No matter how strong those bonds, you recognize that at that age, some may even disregard those closest to them from "their past". Also, you recognize that at that age, being out from under a parent's ever watchful eye, they may act out of a little rebellion.

If she gets in trouble and starts drinking too much, is there somewhere she can reach out? Perhaps there's a program on responsible drinking (and let's imagine such a thing exists that deals with the reality that college students drink despite being underage in most jurisdictions). So let's say there's this responsible drinking program aimed at both those who choose to drink and those who know them. Students are taught responsible drinking behaviors, how to avoid potentially dangerous situations associated with drinking, and how to tell when they or someone they love are in danger of, or have progressed to, problematic drinking.

Here's the Money Question: Would it be appropriate for the college to hire an alcoholic to conduct such a seminar? You know ... one of those functional kinds? Perhaps one that has even had a DUI? Or how about one that has successfully completed a 12 Step program so they're "clean and sober" yet cannot drink at all themselves. How many reading this would feel comfortable with their young lady loved one going to such a seminar when she got in trouble?

Sorry ... that was more than one question ...

What say you?

I would love it if folks could chime in as to under what circumstances you might find this appropriate and/or why you would not. Keep in mind the target audience of this program. And remember, answer as if it was your "young lady loved one". Yes, I specify gender here because when it comes to drinking on a college campus, young ladies are at greater risk for associated dangers such as: (a) passing out or getting too drunk to consent to sexual advances, (b) making poor choices in accepting a ride from a would be predator, (c) alcohol poisoning due to lower body weight/tolerance in general or (d) being slipped a rufie (date rape drug) in her drink. Obviously there are issues for both genders, but I thank everyone in advance for not "going there" into some gender stereotype fighting and infighting.

Totally. some of the best drug counselors are those that have been there. Additionally who better to tell you the dangers of joining a gang than someone who has joined a gang, gone to prison and experienced first hand the affects. It's easy to tell someone not to do it when you never have.

Thanks for the response! Yep, a recovered (key word) addict is well suited to counseling current addicts on recovering themselves. Presumably they are abstaining totally from drugs or whatever and are counseling same. That's not what I'm talking about here though. Clearly there are millions who drink socially that are not alcoholics and drinking moderately does not lead to alcoholism in these people. So the question is should an alcoholic -- either actively or recovered using abstinence -- be counseling on how best to drink responsibly and safely?

To be honest, I have received some of the best advice against some of the most dangerous behaviour by people who have engaged in such behaviour and paid the full price, literally and figuratively, by engaging in such behaviour. I am of the opinion that all experience has teaching value so long as the teacher can objectively convey the real moral of the lesson to the audience rather than remain embroiled in its issues at a personal level.

No, of course not. That is like the fox guarding the chicken coop (in the case of the active but functional alcoholic---funny, it is only in our weird society that a phrase like 'functional alcoholic' could ever be used, though I understand its meaning). I accept that an ex-alcoholic who is completely sober and cannot drink even moderate amounts (without danger of falling off the wagon) might be a better seminar-provider than a current alcoholic, but the best teacher is one who has demonstrated that they can drink responsibly without becoming an alcoholic, despite having gone through a mental health crisis or a personal crisis like depression or divorce where to self-anesthetize or self-medicate with alcohol was tempting. So a well-tested and well-tried moderate drinker, all other things being equal, would be ideal. Certainly not a teatotaller for this topic - the kids would not respect that - it would be like a religious sermon on sexual abstinence (which might only reach 30% of the audience - higher in the US than in Canada).

Of course, these are all generalizations, but it really helps if the person can put themselves in their clients' shoes. Maybe they got into a bit of trouble in college but it did not lead to a lifetime prescription of self-sobriety to escape the dire consequence of long-term alcoholism. Perhaps someone with a family member and direct experience of the effects of alcohol on their loved ones. College kids are going to drink no matter what, but at least they can be coached to drink responsibly, know what situations they should avoid, what the warning signs are, and how not to escalate into problem drinking (like weekend binging).

Having said that, I never got any of this advice, and I did binge drink on weekends (and the occasional weeknight), but because I usually got so sick doing it (often that night and always the next day), I was not "able" to become an alcoholic (physiologically speaking). Perhaps it's bad ADH genes that protected me. Now in my late 30's, I can have the occasional beer or alcoholic beverage and leave it at that. Perhaps I am a bad example, but many college binge drinkers do grow up to become responsible adults, regardless of their college drinking behavior. A large proportion of my medical school class were binge drinkers and every single one of them has become a responsible physician with spouses and children - not an alcoholic among them (as far as I know!!). So perhaps these seminars - which did not even exist in my day - are not really that necessary. Nice, but not mandatory. If anything, we had far more access to alcohol because we didn't matriculate (start college) until we were at the drinking age - but now the freshman year is a whole year under the drinking age (and some even more than that). We had plenty of access to cheap and diverse booze, both on campus and off campus.

I fully empathize with what you are going through with respect to your daughter or niece or loved one. But at some point she is going to need grow wings and fly on her own, and you'll have to let her. If you raised her well in the sense that she has the freedom and awareness and independence to say 'no' to dicey situations, then she will self-protect. At this point, there is very little your worrying over it can accomplish, other than to aggravate you. Or perhaps I am misunderstanding the situation - likely I am, as I don't have all the details and don't know what kind of relationship you have with your daughter.

When I started reading your 'hypothetical,' I thought there was going to be an analogy to overeating. Can someone who's in a situation or has a propensity to 'eat their emotions' be counseled by someone who is a 'formerly obese' person? That's everywhere you look (outside of a doctor's office or medical consultation for diet). The problem is: that formerly obese person may think the secret to successful weight loss is X and you have to do X to lose weight. Problem!

I would hope colleges are more vigilant when they hire people to give health advice. Advice for handling alcohol from someone who couldn't handle it is probably as good as someone who never had a problem. Not only look at the speaker, but look at the audience.

This reminds me a bit of the horrific lectures we got in high school about drinking and driving. The slides were very graphic. I wonder if they give those slide shows today because I can't imagine that parents today wouldn't force the school to allow students to opt out - so kids wouldn't HAVE to be traumatized.

We still drank and drove. Lucky to be alive today, thinking about how much we drank and drove.

I would prefer an alcoholic, now dry, who was never involved in 12-step programs, and who can accepting that drinking is most people's reality and who will mention abstinence as one option (especially when fielding a question from someone who obviously can't handle liquor), but will focus on harm reduction, use their own experiences, and cite Nanji and French.

If, on the other hand, this is some kind of eating analogy, it's a bad one and I can offer no opinion.

Absolutely. A "former alcoholic" would be better, as a dry alcoholic implies 12 Steps and AA is opposed to harm reduction. As a former drug addict I can give harm reduction advice to active drug addicts while encouraging any detox efforts. It's a balancing act, and an active (functional) drug addict or an NA member could not manage this. They are both too invested emotionally in their own position to be objective.

I doubt you can teach people to drink responsibly, except by empathising with, and helping them to understand what was happening on the occasions when they didn't.In other words you can guide people to learn from their experience, and you can warn them about major hazards, and you can model and describe a happy substance-free life, or a life where substances are in control, but to teach responsible drinking itself... That will always be hard given the motivation for drinking is to shed responsibilities.

Yes, because alcoholism is one of the major risks of drinking. A significant proportion of those listening will be susceptible to alcoholism. But they need to address that there are also risks for non-alcoholics.Responsible drinking in a school-age setting also means - perhaps more than anything - being responsible for other drinkers, keeping drunk peers safe. There is a risk an alcoholic would be too wrapped up in their own experience to do this aspect justice.

Was there a typo in your first response? "Now dry" should have been "not dry"? Because now you say dry implies AA/12Step.

In any case, I agree with some of what you say about AA/12Step. I've known two people who didn't fare well with AA that eventually fixed themselves up by going dry and then slowly incorporperating some alcohol in social situations. It is sad but true that many alcoholics simply need to find a whole new set of friends when they recover through AA. Most need to avoid situations where alcohol runs freely altogether, or if they attend parties friends tend to be uncomfortable drinking around them, there's resentment, all that. Both of these people were convinced that if they took that drink at a party they would inevitably end the night in a drunken stupor after AA -- I do believe there's a bit of a self fulfilling prophecy thing there.

Then again I've known people who simply can't ever handle alcohol and for whom AA saved their lives.

Yeah college and drinking seem to go together. The frat I used to go to to study Organic Chem had a keg on tap in the kitchen at all times! I'm not sure it was really any better or worse back then, but the drinking age was 18 so everybody could drink legally. There was a lot of drinking back then ... less binge drinking though I think ... more just a lot! I don't think I know of a single friend/classmate that went on to become an alcoholic despite that, though I do know a few GPA's that suffered!

I'm afraid you took my post a little too seriously. As stated up front, it was a hypothetical, I don't have a daughter or anyone in mind with this problem. It's actually an analogy I have in mind. But I do think such programs might be a good idea implemented correctly. A few years ago I went to a work party with my husband. We were the oldest people there and most of the attendees were like 20 if that. Some strangers came to the party. Lots of booze. I noticed that this one girl was very drunk. None of her friends she came with seemed to notice. Then I noticed her walking up the driveway with three guys who had come later. I went and asked someone if they knew the guys, if they knew if she knew them, and decided to go get her. I asked them her name, they didn't even know that much. They said they were going to walk her home. I said I'll handle that, please leave. I see a lot of this going on ... I probably did similarly stupid shit in my day and just got lucky, but mostly I've had a pretty good tolerance for alcohol and good friends around when I overdid. Ahhh youth. It's amazing anyone gets old really ;-)

You make a great point in the second paragraph. Not sure I agree with the first paragraph or understand your point fully though.

Would you say it's fair to say that an alcoholic might view alcohol with more "skepticism" than your average social drinker? In other words, see the potential for anyone to become an alcoholic and perhaps needlessly focus on this risk and offer up too many dire warnings?

I think anyone except a current alcoholic would suffice. Ideally someone who has first hand experience with alcoholism would be preferable, whether it be a moderate drinker who has lived with an alcoholic, or someone who is recovered. I wouldn't put much trust in someone who's trying to counsel others based on books and a few training classes though with no real world experience. And I'm mainly talking about detecting problematic drinking, not so much telling people how to avoid risky situations.

Just as a moderate drinker may think becoming an alcoholic is simply a matter of choice as opposed to being driven by genetic factors, and they may simply counsel the problematic drinker to drink less instead of abstaining completely when that would be the more appropriate course of action, since the moderate drinker finds it rather easy to just drink less.

Yeah detecting problem drinking is a biggie. I don't think anyone is more suited to that than a recovered teetotaler, although they may be hypersensitive and biased towards seeing any drinking as potentially problematic. A recovered alcoholic that is still drinking may run the risk of rationalizing and such. I would disagree though that depending on the training, someone who has never had a problem could learn to recognize them. But a 10 hour certification or something probably isn't that. This would likely involve some formal "book learning" and then a whole lot of internship/clinical training working with alcoholics and such to get a real world view.

Well you don't need to be a college football fan. It is headline news. And it addresses exactly what you are addressing. How to tell a young woman about the dangers of drinking and non consensual sex. Because I have seen many non consensual women, become consensual. And regret every moment of it. Drinking is a hard nut to crack in the average teenage head. When I was a kid, we had disdain for the booze hounds. Rednecks. Would love to a return of those days. Now, I was smoking dope in lieu of booze. If a young woman or man could get legally intoxicated as part of .....dumb ass 101. And film it. Might make a dent in the psyche..........but doubt it. Good parenting goes a long way, the rest is left up to inherent brain matter. Or lack of.

Ahh ... I do follow the news but didn't catch this update to story. It happened a year ago and I do remember something but didn't connect to your reference.

The problem with a lot of this is that one really does never know the truth unless it's on tape in a he said/she said (unless there is sufficient physical force to leave marks). I am in favor of lowering the drinking age and/or allowing older teens to drink in the home etc. Getting blotto for the first time away from home is generally not going to end well unless you luck out with your choice of company.

Yes, but how are we going to determine if the young lady really needs the program? Does she LOOK like what I think an alcoholic looks like, or like she's "healthy"? And is the seminar going to be conducted according to "scientific evidence" or "clinically tested studies" (AKA those clearly in the thrall of Big Rehab)? Or is there going to be a proper maverick guru in charge who is brave enough to buck the "common wisdom", and also look like what I think a sober person ought to look like, regardless of any behaviors he/she exhibits? That's how you decide, really.

Read a great quote and thought of you. It went something like this -- people who are insecure about themselves and carry a chronic sense of unworthiness or insufficiency are often drawn to extreme ideologies and belief systems that promise them personal "purification" (whether physically, spiritually, mentally, psychologically, etc), so that they might one day become a better, more improved version of their old selves. People who are happy and comfortable in their own skin have no need for such ideologies. I wonder if this applies to things like carbophobia, orthorexia or health-based vegan diets. Such individuals come to see the entire world filtered through the looking glass of their new belief system, dividing people into 'cognoscenti' (those who know - like them) and 'ignorant dolts' (those who don't know). No wonder it's called "drinking the koolaid".

I think this is an important point that's really tangential to this post. I also think that there's a continuum at play ... it's not just people who feel chronically unworthy who are drawn to be part of these communities. I've lately been drawn to work by evolutionary psychologists and others looking at how this plays out in modern society (e.g., John Cacioppo's Loneliness and Paul Keedwell's How Sadness Survived). We needed meaningful and active community participation to survive for most of our existence, so I can see why people might be drawn to substitutes.

I probably misquoted the book ("Radical Acceptance" by Tara Brach, PhD). I will have to go get it and rewrite the quote. Dr Brach writes that the vast majority of us have, at least occasionally, these feelings of insufficiency. Perhaps those with stronger feelings of insufficiency are drawn towards pernicious cult-like influences such as carbophobia and orthorexia (here I am extrapolating - it's my own hypothesis with respect to these nutritional communities). But in general these online communities offer security, the chance to be purified, social acceptance, a doctrine one can follow, a feeling of superiority over others (smugness) ... what more could one want? (except for real relationships and real self-acceptance, warts and all).

I don't disagree ... my point was just that there seems to be a strong evolutionary basis for this. And even the paleo and ancestral health folks seem to just gloss over this if they even mention it at all.

Unfortunately, it's become too easy to say that something has an evolutionary basis -- though I admit I have not read the two books you mentioned (by John Cacioppo and Paul Keedwell), and maybe I should before I make this statement. I find that a lot of the paleo diet adherents cite evolutionary arguments. While there is a good deal of science in paleoarchaeology and anthropology, none of us can actually go back to that time to see for ourselves what in our modern psyche is evolutionarily based and what is not. In the recent popular literature, much of it seems to boil down to "thought experiments". And as a highly adaptive species readily capable of exploiting multiple, diverse ecological niches, it is probable that we have changed considerably since those days of our ancestors. The internet - for example - is completely new, but it seems we have adapted rapidly to it -- is that because of evolution?

I do not mean to be dismissive of arguments made by evolutionary psychology, but I am not sure of their value versus more traditional schools of psychology for explaining these disorders.

there is a body of literature on this that I've been coming across in bits and pieces for many years, from Pinker to Gilbert to Baumeister ... and I recently found much of it laid out and "cohered" for me in Timothy Wilson's book "Redirect". The actual person that delivers the lesson may not be that important. The most important piece is the narrative structure or story and/or self label that the student takes away

the ideal would be to expose the at-risk person to useful lessons (Exposure to ex-alcoholics may be a useful part of this) WITHOUT giving them the idea that they are at risk.

Also keep them away from other at-risk individuals (Wilson goes over studies that tested both of these components, the "scared straight"[1] and the social context/milieux, and studies that botched previously successful protocols to tease out helpful and unhelpful components).

Eating disorders I have zero ideas on.

[1] Wilson goes over that famous intevention and descendents and variations, including its "spiritual opposite", which also flamed out spectacularly)